Multi-Drug Desensitization Protocol for Heart Transplant Candidates

Stopped early · Phase 2

Conditions studied: Heart Transplantation

In brief

Background: Patients may develop antibodies (human leukocyte antigen \[HLA\] alloantibodies) to other human tissues via pregnancy, transfusions or previous transplantation, which limits the ability to find an acceptable donor heart for transplantation. Such patients are at high risk for antibody mediated rejection, graft failure, and acute rejection (i.e. death). For successful transplantation, patients must receive organs from donors who lack the HLA antigens that correspond to their alloantibody specificities. No successful desensitization strategy currently exists. Purpose: To determine if desensitization by deletion of immunologic memory with a multi-drug approach including anti-T and B cell therapies and anti-plasma cell therapy can effectively eliminate or significantly reduce alloantibody levels and permit highly sensitized patients to obtain a heart transplant. This therapy is anticipated to remove immunologic memory and will require re-immunization.

Key facts

Study ID: NCT01556347
Run by: Providence Health & Services
People needed: 2
Starts: 2012-07-01
Expected to finish: 2016-05-01
Last updated by the study team: 2018-06-15

Who can join

Age: 18 and older, up to 67. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

1. Voluntary signed informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
Female subject is either post-menopausal or surgically sterilized, or willing to use two acceptable methods of birth control for the duration of the study and for up to 2 months after the last dose of study medication.
Male subject agrees to use an acceptable method for contraception for the duration of the study.
Patient is greater than or equal to 18 years of age but less than 70 years old (inclusive).
Patients with a Calculated Panel Reactive Antibody (CPRA) of ≥ 50% by Luminex Single Antigen Flow Bead (SAFB) testing (LABScreen®, Canoga Park, CA), where a Mean Fluorescence Intensity (MFI) of 1000 is the positive threshold.
Patient is considered compliant and intends to be available for follow-up study period of 1 year.
Patient must have no known hypersensitivity to treatment with bortezomib, boron, or mannitol.
Patient must have no hypersensitivity to rituximab. 9.Patient must have no history of allergy or anaphylaxis to rabbit proteins or to any product excipients, or have active acute or chronic infections which contraindicate additional immunosuppression.
Patient must have no history of an anaphylactic or severe systemic response to Immune Globulin (Human). Individuals with selective IgA deficiencies who have antibody against IgA (anti-IgA antibody) should not receive IVIG since these patients may experience severe reactions to the IgA which may be present.
Patients without an AICD implanted will need to consent to wear a Zoll LifeVest Wearable Defibrillator.

You may not qualify if…

Women who are pregnant, breastfeeding, or have a positive pregnancy test on enrollment. If the patient becomes pregnant during the study, she must be removed from the study before receiving any additional study drug.
History of hepatitis C virus (HCV) positivity (by polymerase chain reaction, PCR)
Patients who are human immunodeficiency virus (HIV)-positive, or hepatitis B surface antigen (HBsAg)-positive.
Patient is deemed likely to have a second solid organ transplant or cell transplant (e.g. kidney or islet cell) in next 3 years.
Patient at risk for tuberculosis (TB):
Current clinical, radiographic, or laboratory evidence of active or latent TB as determined by local standard of care
History of active TB:
Within the last 2 years, even if treated
Greater than 2 years ago, unless there is documentation of adequate treatment according to locally accepted clinical practice
Patient at risk of reactivation of TB precludes administration of conventional immunosuppression (as determined by investigator and based upon appropriate evaluation)
Patient with active peptic ulcer disease (PUD), chronic diarrhea, or gastrointestinal malabsorption
Patient with a history of hypercoaguable state
Patient with hemoglobin < 7 g/dL, white blood cell (WBC) count < 2000/mm3 (3 x 109/L) or platelet count < 30,000 /mm3 prior to transplant
Receipt of a live vaccine within 4 weeks prior to study entry
Patient treated with immunosuppressive therapy (e.g. methotrexate, abatacept, etc) for indications such as autoimmune disease, or patient with comorbidity to a degree that treatment with such agents is likely during the trial in the opinion of the investigator
Patients with current or recent severe systemic infections within 2 weeks of medication start
Evidence of severe liver disease with abnormal liver profile (aspartate aminotransferase [AST], alanine aminotransferase [ALT] or total bilirubin > 1.5 times upper limit of normal (ULN) at screening.)
Patient has ≥ Grade 2 peripheral neuropathy within 14 days of medication start
History of malignancy within the past 5 years that is not considered to be cured, with the exception of localized basal cell carcinoma of the skin (excised ≥ 2 years prior to study initiation)
Prisoner or patient compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g. infectious disease) illness
Patient with a history of substance abuse (drugs or alcohol) within the past 6 months, or psychotic disorders that are not compatible with adequate study follow-up
Patient with a history of amiodarone exposure within three months.
Patient with a previous heart or other transplant

Where it is running

Providence Sacred Heart Medical Center — Spokane, Washington, United States

Full record on ClinicalTrials.gov

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